Before delving into the myriad wrinkle
solutions, it is important to understand why wrinkles form in the first place.
For the most part, the decline of skin supporting collagen is to blame, and this
is caused by two factors. First, our skin produces collagen over time. Second,
eternal factors, like the sun, damage the existing collagen. When this happens,
the support system that keeps skin plump and springy begins to falter, and as it
weakens, fine lines and wrinkles become apparent.

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Collagen Helix Molecule Structure

Collagen provides structure and is
essential for healthy, plump skin. Over time our bodies naturally lose collagen
and begin losing less of it. Once collagen levels become depleted, moisture
levels diminish and elasticity is lost – the result is wrinkles, lines and loose
skin. When it is young and elastic, the skin has support and literally wraps
itself around the face. However, as we lose collagen, the skin thins.

Similar to collagen, elastin is the key
for flexible, healthy, youthful skin. But with age, the amount of elastin that
the body naturally produces begins to decrease. When there is less elastin
present in the skin, it can droop and sag.

Skin that has lost its elasticity
cannot tighten itself around the underlying bone and muscle structure, causing
drooping and sagging. The skin doesn’t progress in terms of elasticity, which is
why some procedures, like a facelift, are not the best option for treating
wrinkles, but are better for reshaping the face and restoring smooth contours.

Environmental factors including
over-exposing your skin to the sun or UV light as in a tanning bed can cause the
skin to lose collagen to break down and cause pre-mature aging. Other factors
that contribute to the break down of collagen include pollution, smoke and the
weather.

Facial expressions also, unfortunately
can cause collagen loss. It is nearly impossible not to smile, laugh, frown or
squint your eyes – but with every facial impression made can contribute to the
break down of collagen in your skin.

Collagen loss can contribute to the
signs of aging on your face. The crow’s feet with the outer corner of the eyes
and upper and lower eyelids show the signs with becoming saggy and baggy as
collagen levels become depleted. Tear troughs (deep hollows under the eye
sockets) can also form. Depleted collagen can also cause drooping brows. When
the eyebrows droop, they can become hooded and fall over the eyelids. The
nasolabial folds show the lack of collagen with becoming more pronounced, and
fine lines increase. The lack of collagen, elastin, and volume will make jowls
saggy with excess skin showing an unrefined contour. Lost collagen also leads to
thin lip lines, along with losing volume with the lips thinning out.

Illustration by Renée Gordon. Source: National Institute
on Aging. Used with permission

Replacement fillers are designed to work
by restoring lost volume or filling furrows. Studies have also shown that by
stretching the skin or epidermis and creating an injury of sorts, these
injectables may actually prompt a tiny bit of new collagen production.

In a “perfect world” the perfect dermal
filler should be inexpensive, safe, painless to inject, hypoallergenic, and long
lasting. We do have a variety of new and existing fillers on the market, but
each one comes with their own pros and cons. Ultimately we all want to see the
biggest improvement for the least amount of money with the best results. Also,
these fillers should have consistent and predictable results, feel natural under
the skin, take little time to inject, be ready-to-use, exert no downtime on the
patient, and have a low risk of complications.

The aging “baby boomers” want a
quick fix – so the pharmaceutical companies have complied with a variety of
dermal fillers to fit any lifestyle. This area of dermal fillers and getting a
lunch-time procedure, has been the fastest growing segment of the cosmetic
surgery boom during this last decade.

Considerable advances in technology have
given the cosmetic surgeon a selection of filler options. Still, no one filler
can address every patient’s concern. Treatment should be tailored to the
patient’s individual needs to achieve maximal benefit, minimize risk, and
achieve the desired correction durability.

Smile
Lines aka Nasolabial Folds:
The Nasolabial Folds run from the side of the nose down to the corner of the
lips. This area is also referred to as the "Prentices".
Sometimes these folds can wrap partially around the base of the mouth. Everyone has nasolabial folds however it is the depth of these folds that
vary. This feature can and does become more pronounced as we age. There are many reasons why the nasolabial fold becomes deeper and more
pronounced with age. The most common reason is the slow migration of
the cheek fat moving down lower on the face. People who have thin or
aging skin tend to wrinkle more easily. Sun-exposure and or
expressions of smiling and laughing all contribute to the nasolabial area.

Marionette Lines: Also
known as "Oral Commissure". These lines run from the corner of the
lips down to the chin area. These are vertical lines that run downward
from the outer corners of the mouth along the outside of the chin.
Sometimes, these lines can look like an extension of the nasolabial folds. These lines got its name because of their resemblance to the lines that
appear in the face of marionette puppets or ventriloquists' dummies.

Vermilion Border:
This area is the border of the lips (the area that gives the lips
definition. Exposed margin of the upper or lower lip area. It
extends from the junction of the lips to the surrounding facial skin on the
exterior to the labial mucosa within the mouth.

Vertical
Lip Lines: These
lines are caused from patients who smoke. Tiny lines are
noticeable above the vermilion border of the lips. Lip tissue is soft
tissue - which adds fullness and definition to the lip area. When
lips lose definition and shape, the mouth area can look withered and drawn
or misshapen. Lines of the lips are due to several factors which
include loss of volume, loss of bony and dental structure, loss of
elasticity and repetitive use.

Crows Feet:
These lines or wrinkles radiate outward from the corners of the eyes. Caused by many factors normally responsible for the wrinkling of skin
including sun exposure. Not wearing sun-glasses contributes to these
lines. Repeated facial movements or expressions including laughing,
smiling or squinting will make these lines more noticeable.

Tear Trough:
This area is located near the nose and the lower eyelid. Loss of volume can
create a hollow appearance under the eyes. With filling the tear
trough, the goal is to fill the hollows below the eye and to lift the
cheek to provide a more natural contour between the two. This will
effectively reduce the appearance of the hollow out area. Tear
troughs respond well to fillers such as Restylane and Juvederm.
Fat grafting can work extremely well and may be the most
natural way to rejuvenate this area.

Frown Lines aka
Glabellar Line:These deep creases form when
the brow area is furrowed. These frown lines also are a result of
wrinkling the nose or making a face. These lines are the result of
facial muscles developing the habit of wrinkling over time, and they are by
far some of the hardest types of aging to combat or repair.

Forehead Lines:
These lines run across the forehead area and can be categorized into three
different areas: Mild - Moderate - Severe. Most of these lines are
considered expression lines which are hard to prevent. Forehead
wrinkles are caused from repeated expressions of worry, concern and
sometimes surprise. Over the years these wrinkles become fixed and
deeper.

Facial Scars: Sometimes
scars that occur on the face have a tendency over time to become "drawn in"
as the aging process begins. Fillers can help this area as well as
other treatments including a scar revision.

As with all facial or lip injections
pain relief is a very common question. With the hyaluronic acid fillers, because
they are delivered through a larger gauge needle, sometimes a sensitive patient
will have to have a nerve block or a dental block.

The dental blocks of course are more
invasive than a topical cream, but are much better for pain relief. The
block is performed by injecting 1 to 2 cc of local anesthetic right next to
where a major nerve group comes out of the bones of your face.

The entire
segment supplied by this nerve bundle then "falls asleep" for 1 to 4 hours. If
the block is performed through the mouth using some numbing cream or spray at
the injection site, it can be painless. There are relatively few nerve receptors
inside the mouth, and those are very susceptible to the topical creams.

EMLA Topical Cream is a local anesthetic which works
by blocking the nerves from transmitting painful impulses to the brain. It
numbs the skin to pain from injections (dermal or lip fillers).

EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) is
an emulsion in which the mixture of lidocaine and prilocaine is a ratio of 1:1
by weight. It is packaged in 5 gram and 30 gram tubes.

EMLA Topical
Cream is available by prescription only.
Your physician will either supply you
with a tube or will write a prescription
to pick up at the pharmacy for use
before your dermal filler / lip augmentation
or BOTOX
appointment.

Photo courtesy of AstraZeneca - EMLA Cream

EMLA Cream Indications:

EMLA is indicated as a topical anesthetic cosmetic procedures for dermal fillers.

normal intact skin for local analgesia and superficial minor surgery as pre-treatment for infiltration anesthesia.

EMLA Cream should be used the
following way:

Wash and
dry the area to be treated. Apply a
thick layer of cream to the affected
skin - never rub EMLA into the skin.

EMLA Cream
should not be used on broken or
damaged skin.

Avoid
getting EMLA Cream in the eyes,
nose, or mouth. If by accident
it should get in the eye area, rinse
with plenty of water. If swallowed,
call your local poison control
center.

Wash your
hands after using EMLA Cream.

Apply EMLA
Cream at least 20 minutes before the
treatment.

The
numbing effect will last
approximately an hour after the
procedure.

Make certain you
have soft, flexible, cool compresses available for the first 24 hours after
treatment.

It is important that
you not exert yourself with exercise or any activity that can increase your
blood pressure in the first 24 hours after treatment. This can increase the
potential for swelling and bruising.

Have a good,
rub-proof, sweat-proof non-irritating concealer or camouflage make-up
available to touch up any discoloration after treatment.

Needle sticks may
bleed a bit after treatment. You may apply an antibiotic ointment to the
treated region.